Acute angle closure glaucoma (Guidelines)



  • Highland Health and Social Care Partnership
  • Primary and Secondary Care

Signs and symptoms


  • Pain
  • Blurred vision
  • Coloured haloes around lights
  • Frontal headache
  • Nausea and vomiting


  • Hazy cornea
  • Red conjunctiva
  • Mid-dilated pupil that doesn’t respond to light
  • Patient usually elderly and long-sighted
  • Measure intraocular pressure if possible (Ophth nurses on NTC Ophthalmology) – pressure will be greater than 35mmHg


  1. Admit NTC Ophthalmology 
  2. Actetazolamide 500mg IV stat then 250mg orally (or IV) 4 times daily
  3. Latanoprost eyedrops once daily, Timoptol 0·25% eyedrops twice daily, Iopidine 1% eyedrop 3 times daily, Pilocarpine 2% 4 times daily - all to affected eye
  4. If still pain/vomiting 2 hours after above treatment giveMannitol10% 250ml IV infusion over 30 minutes unless contraindicated (see resources). 
  5. Nurse supine
  6. Arrange for follow up with Ophthalmology that day or, if out of hours, the following day

Editorial Information

Last reviewed: 14/02/2023

Next review date: 28/02/2026

Author(s): Ophthalmology Review Group.

Version: 1

Approved By: TAM subgroup of the ADTC

Reviewer name(s): Dr T Leslie, Consultant Ophthalmologist .

Document Id: TAM555